Symptoms
THE MOST COMMON SYMPTOMS - of TMJ disorders are headaches, ear pain, facial pain, and neck pain. Other common symptoms include difficulty chewing and swallowing, limited mouth opening, unexplained (phantom) tooth pain, headaches (including common migraines), blocked eustachian tubes (stuffy ears), dizziness (vertigo), ringing or whooshing sounds in the ears (tinnitus), and chronic postural tension.
VARIETY - TMJ disorders can produce such a wide variety of symptoms that the Journal of the American Medical Association called it "the great imposter". All these symptoms rarely occur together in one patient, and most patients suffer from only a few of them. For example, some only experience headaches, some only experience facial pain, and some only experience ear problems. A few people also suffer from unusual visual disorders or idiopathic neurosensory disorders, like twitching or numbness, that sometimes respond to TMJ disorder treatment along with the other symptoms, although we don't understand the mechanisms involved. Even neurologic conditions of unknown etiology, like Tourette's syndrome, are sometimes eliminated by TMJ treatment; but not by any particular type of TMJ treatment.
TMJ INFLAMMATION - is a specific stage of the disorder, which usually occurs shortly after the initial disk dislocation or after it progresses to a closed lock. At this stage, the problem is intracapsular, because the joint capsule is swollen. The swelling of the joint capsule pushes the affected condyle down and away from the skull, like expanding a bag of water under a table leg, which separates the back teeth on that side. Biting forcefully to try and contact those separated back teeth triggers immediate pain by driving the condyle into the swollen area. The pain can be temporarily eliminated by biting on a small object like a tongue blade placed between the second molars on the side of the inflammation, behind the main vector of the jaw closing muscles, where biting on the object pries the condyle slightly down and away from the swollen area, which immediately eliminates the pain.
TIGHT JAW MUSCLES - always accompany TMJ disorders, because the jaw muscles automatically increase their constant background tension (tonus) in response to TMJ inflammation or an unstable or displaced bite. TMJ inflammation triggers jaw muscle tightening, because muscles automatically tighten up to protect injured or unstable joints. An unstable bite triggers jaw muscle tightening, because the bite functions like a joint between the upper and lower jawbones, and the state of a joint determines the tension in the muscles which cross that joint, in this case the jaw muscles crossing the TMJs. A displaced bite triggers asymmetrical jaw muscle tightening due to the muscles straining to keep the resting posture of the mandible beneath the displaced bite table. Also central nervous system stress can add to the increased jaw muscle tonus by further tightening all the body's skeletal muscles.
FACIAL PAIN OR SORENESS - the primary symptom of a TMJ disorder, results from the effect of increased jaw muscle tonus on the muscle capillary beds. When tonus goes up from one percent to two or three percent, the compression of the capillary beds can prevent resting circulation from being able to adequately flush out the waste products of metabolism. Little pockets of waste products that form present clinically as trigger points - pea shaped nodes that are exquisitely sensitive to manual pressure. When these trigger points are forcefully compressed with a finger, they can cause pain in the teeth or at locations surprisingly far away in typical "pain referral" patterns, which can persist long after their original cause has been eliminated. In this manner, the jaw muscle tension causes the pain, but the TMJ inflammation or the unstable bite is the cause of the jaw muscle tension.
CONTRACTURE - An anatomical shortening of the jaw muscles, can occur after the tightness has become chronic. If your jaw muscles are in contracture, your mandible will no longer hang open very far when you are at rest. Your teeth may even be held in contact or clenched for long periods of time during the day. After this condition has persisted for a long time, the shortened postural position can become "cemented in" with fascia, requiring forceful stretching to restore normal resting lengths to the involved muscles.
POSTURAL STRAINS - are always involved, because the mandible is part of the neck, and the jaw muscles are part of the head posture mechanism. Many health practitioners point out that postural strains can misalign the jaw, but few understand how a misaligned jaw can cause postural strains. Backward jaw posture causes forward head posture, and laterally shifted jaw posture causes the head to tip to the side of the shifted mandible. The mechanisms behind these changes are explained in detail in BITES AND BODY POSTURE under the FOR DOCTORS tab.
TRIGEMINAL NEURALGIA - is a condition characterized by unpredictable sudden and extreme attacks of pain that have been described as feeling like you've been run over by a train. It is often misdiagnosed as the cause of TMJ disorder pain. The pain of trigeminal neuralgia may be similar to an acute TMJ disorder, but the epidemiology is not. Trigeminal neuralgia is rarely found in people under middle age, while acute TMJ disorders are rarely found in people above middle age. The cause of trigeminal neuralgia is not an inflamed TMJ or tight jaw muscles. The cause was thought for some time to be pressure from the brain on the trigeminal nerve, leading to decompression brain surgery, but more recent MRI evidence indicates that glymphatic dysfunction is involved. The glymphatic circulation system is described in CRANIAL AND CRANIOSACRAL under TREATMENTS.
HEADACHES - are the second most common TMJ disorder symptom, but not any particular type of headache. In fact, your description of your headache does not tell us anything about its cause. The jaw muscles attach all over the sides of the head, and the pressure they produce can disrupt cranial (glymphatic) circulation, leading to irregular CSF pressures in localized areas of the cranium. This can cause sinus headaches, temporal headaches, occipital headaches, or common migraines. One recent study described migraine and a "brain clearance disorder". Recent MRI studies suggest that the closure of the perivascular spaces, which results in impaired clearance of waste products from neural metabolism into venous circulation along perivenous pathways, usually precedes migraine. Headaches are usually described as feelings of pressure, impaired glymphatic circulation could certainly produce localized increases in intracranial pressure, and there is no evidence that the pressure frequently described in headaches is not real or that the pressure sensors in our cranium are not accurate like all our other pressure sensors. We don't yet have intracranial pressure sensors sensitive enough to detect small localized deviations of CSF pressure, to which the brain could be much more sensitive than we can currently measure, and it's certainly plausible to postulate that localized areas of increased intracranial pressure due to the failure to adequately regulate glymphatic drainage in those regions could cause the pain. Also any cervical constriction, such as a forward or twisted head posture, can impede glymphatic drainage into the venous and lymphatic channels at the base of the neck and lead to a build up of CSF pressure in the cranium. The glymphatic circulation process is described in CRANIAL AND CRANIOSACRAL under the tab TREATMENTS.
EAR SYMPTOMS - include dizziness (vertigo), tinnitus (ear ringing), stuffiness (blocked eustachian tubes), and frequent difficulty hearing what people say (subjective hearing loss). There are two common causes of these ear symptoms in TMJ disorders.
One cause of the ear symptoms is tight muscles. The jaw and ear muscles share the same motor nerve and therefore tighten together. The tensor tympani muscle functions by tightening the ear drum to protect it from loud noises; so increasing its resting tonus can cause tinnitus by applying pressure to the drum or cause subjective hearing loss by not maintaining a resting posture that is ready to hear, causing you to miss things that people say; even though your hearing tests, when your ear is ready to hear, may show normal results. The tensor veli palatini muscles pull open the eustachian tube during swallowing and yawning, so increasing its tonus can leave it unable to equalize pressure between your middle ear and the outside air, which makes your ears feel blocked or stuffy, or makes them unable to clear when changing altitude like going in a plane or over a mountain.
The other cause of the ear symptoms is fluid pressure from a swollen TMJ capsule. The back ends of the TMJs, where most of the TMJ bruising occurs, are located only 1.5 millimeters from the front of the middle ear; and inflammation from chronic bruising of the retrodiskal TMJ tissues can produce increased fluid pressure that can easily cross the thin membrane bones separating them from the ear. The increased fluid pressure can then disrupt the balance mechanism in the inner ear by increasing fluid pressure in the endolymphatic sacs. The increased fluid pressure can also impair the ability of the inner ear to clear its waste products, like the glymphatic drainage needed to clear the brain of waste products. Tracer studies show rapid access of injected markers to the perilymph spaces and clearance through perivenous channels, like clearance of CSF from the brain. In this perspective, dizziness may also be a fluid clearance disorder. A recent study found that tinnitus was associated with impaired glymphatic circulation and increased water. (Weijie Y, Yinjuan D, Shuo L, et al. Altered Glymphatic Function in Tinnitus: Associations With Cognition and Effects of rTMS.Laryngoscope, January 2026)
The increased fluid pressure from a swollen TMJ capsule can also push closed the eustachian tubes, which pass just behind the TMJs. After the tubes have been pushed closed for long enough, they become narrow in the area just behind the TMJs.
INDICATOR SYMPTOMS - Whatever symptoms characterize your TMJ disorder generally move together in the same direction, but not at the same speed. The more rapidly responding symptoms serve as indicator symptoms - they let us know if the treatment is on track. Pain is the best indicator symptom, even mild pain such as chronic ache or facial soreness. The ear symptoms are the worst indicator symptoms, because their response is more irregular.
EPIDEMIOLOGY
CHILDREN - rarely suffer from serious TMJ disorder symptoms, because their extensive capacity for growth adaptation will change their facial structure to accommodate even extreme bite strain. Thus their faces will grow crooked rather than allowing the strain to create tissue damage. The crooked growth typically leads to airway and postural problems later in life.
WOMEN - are much more commonly affected than men, because their more downward and backward facial growth pattern diverges from the average male facial growth pattern at puberty, when females start showing significantly more signs and symptoms of TMJ disorders. This difference in male and female adult facial growth patterns is illustrated in CAUSES under the tab FOR DOCTORS.
THE ELDERLY - rarely experience TMJ inflammation, because damaged TMJs heal anatomically due to fibrosis of the retrodiskal tissues. This successful adaptation can take a day or a decade, but it almost always occurs by middle age. Older people can still suffer from jaw muscle pain as a subset of postural muscle pain, because the mandible is an integral component of the head posture mechanism, and they can have difficulty chewing due to an unstable or displaced bite. However, they are unlikely to develop an acutely painful TMJ disorder, unless they have an extremely strained bite, worn out dentures, or a systemic arthritic condition like rheumatoid arthritis that happens to attack the TMJs. Also any TMJ injuries that the elderly experience usually respond quickly to simple treatment or even just time. These joints were designed to undergo many injuries and still function adequately.
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